Tuberculosis Resurgence Sparks Growing Public Health Concern

The United States is witnessing a concerning resurgence of tuberculosis (TB), with Kansas currently experiencing the largest documented outbreak in the nation's history. Since 2024, 67 active cases and 79 latent infections have been reported in Wyandotte and Johnson counties.

According to some public officials, the resurgence of tuberculosis in the U.S. coincided with record levels of illegal immigration, touched off by lax border enforcement.

Senator Todd Young (R-IN), who supported the "End Tuberculosis Act," says TB is a treatable and preventable disease.

Tuberculosis is a preventable, treatable, and curable disease. More than 25 years after it was declared a public health emergency, TB still remains one of the deadliest infectious health threats and often goes undiagnosed in many countries.

Jill Bronaugh, communications director for the Kansas Department of Health and Environment, described the outbreak as the "largest documented tuberculosis outbreak in U.S. history" since the Centers for Disease Control and Prevention began monitoring and reporting cases in the 1950s.

Vulnerable Populations Have Difficulty Fighting TB

According to the Cleveland Clinic, tuberculosis spreads when a person with active TB disease releases germs into the air through coughing, sneezing, talking, singing, or laughing. Only individuals with an active pulmonary infection are contagious.

The Cleveland Clinic notes that most people who inhale TB bacteria are able to fight the infection and prevent it from growing, resulting in a latent TB infection. An estimated 13 million people in the U.S. have latent TB, where the bacteria remain alive but inactive in the body. In some cases, a person may carry latent TB for a lifetime without it ever progressing to active TB disease.

However, latent TB can become active if the immune system weakens and is unable to stop the bacteria from multiplying. Researchers are actively working on treatments to prevent latent TB from becoming active.

This alarming trend is not isolated to Kansas; other regions are also reporting increases in TB cases, underscoring the need for heightened awareness and proactive measures nationwide.

National Overview

While Kansas faces a significant outbreak, TB remains a persistent public health challenge across the United States. In 2023 (most recently released data), the Centers for Disease Control and Prevention (CDC) reported 9,633 TB cases nationwide, reflecting ongoing transmission and the need for vigilant public health efforts.

Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, says the number of infections globally is also increasing.

The fact that TB still kills and sickens so many people is an outrage, when we have the tools to prevent it, detect it and treat it.

Impact on Older Adults

Older adults are particularly vulnerable to TB due to age-related declines in immune function and the presence of other health conditions. The disease often presents atypically in this population, leading to delays in diagnosis and treatment. Symptoms such as weakness, loss of appetite, and cognitive changes can be mistaken for normal aging or other illnesses.

The microbe that causes this infectious disease, Mycobacterium tuberculosis (Mtb), currently kills more people in the world than any other pathogen.

Professor Joanne Turner, Ph.D., Vice President for Research for the Texas Biomedical Research Institute, says TB is dangerous for older people because things go wrong as we get older.

When we're younger, we have control mechanisms in place, and our body will switch on responses and switch off responses as needed. As we get older, some of those responses become defective.

Experts say that given the subtlety of symptoms in the elderly, TB can easily be overlooked. Healthcare providers must maintain a high index of suspicion, especially in patients with prolonged respiratory symptoms or unexplained weight loss.

Symptoms and Diagnosis

TB primarily affects the lungs but can involve other parts of the body. Common symptoms include:

• A persistent cough lasting more than three weeks
• Chest pain
• Coughing up blood or sputum
• Unexplained weight loss
• Night sweats
• Fever
• Fatigue

In older adults, symptoms may be less pronounced or atypical, such as confusion or general malaise.

Diagnosis involves a combination of medical history, physical examination, and diagnostic tests. The tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are commonly used to detect TB infection.

Chest X-rays and sputum tests help confirm active disease. In older adults, additional challenges such as cognitive impairment and communication difficulties can complicate the diagnostic process.

Working to Prevent TB Infection

Healthcare providers are intensifying efforts to manage and prevent TB, particularly among vulnerable populations like older adults. Strategies include:

• Enhanced Screening: Regular TB testing for high-risk groups, including residents of long-term care facilities.
• Timely Diagnosis: Utilizing comprehensive diagnostic approaches to identify TB cases promptly.
• Effective Treatment: Administering appropriate antibiotic regimens and monitoring for side effects, which may be more prevalent in older patients.
• Public Education: Raising awareness about TB symptoms and the importance of early medical consultation.

Early detection and adherence to treatment are crucial in controlling TB spread. Given the complexities in older adults, a tailored approach is essential to ensure successful outcomes.

Older adults remain a high-risk group requiring focused attention. Through comprehensive strategies encompassing prevention, timely diagnosis, and effective treatment, healthcare professionals aim to curb the spread of TB and safeguard public health, especially for older adults.